Intracellular pathogens are the main cause for increased morbidity and mortality worldwide. The list of intracellular infectious agents that have had a significant impact on global health and economy includes viral pathogens such as human immunodeficiency virus (HIV), hepatitis B and C virus (HBV and HCV), Influenza, Epstein Barr virus (EBV), protozoan parasites which are the causative agents of Chagas disease, Malaria, Toxoplasma and Leishmaniasis and bacterial pathogens including agents responsible for Tuberculosis (TB), Chlamydia and Leprosy. In spite of decades of research, there is very little progress in the development of effective vaccines against these pathogens, most of the vaccines being the live attenuated pathogens.
Mycobacterium tuberculosis (Mtb) is one of the most ubiquitous pathogens in the world. It is estimated that roughly one third of the world's population is infected, resulting in 3 million deaths per year. Tuberculosis continues to be a major public health issue in many parts of the world due to a) the relatively long period of treatment required to cure it, b) the emergence of drug-resistant strains and c) the rise in HIV infection as a cofactor that facilitates the transmission and progression of the disease.
Currently, a live attenuated strain of Mycobacterium bovis (BCG) is used as a vaccine for children. However, this is not sufficiently effective as it has variable efficiency (0-80%), immunity tends to wane after 10-15 years and it fails to control dormant or new infection.
Despite this, BCG still has value for example in its efficacy against meningeal TB and leprosy. Nevertheless, a more effective vaccine is essential in order to control the spread of TB more effectively. In particular, there is a demand for more effective preventive “pre infection” vaccines as well as “post infection” vaccines that could be administered against a background of BCG immunization and/or pre-existing Mtb infection.
WO 2008/035350 discloses signal peptide based therapeutic vaccine compositions targeted against various tumor associated antigens.